Initial Hormonal Management of Androgen-Sensitive Metastatic, Recurrent, or Progressive Prostate Cancer: 2007 Update of an American Society of Clinical Oncology Practice Guideline

Abstract

Bilateral orchiectomy or luteinizing hormone-releasing hormone agonists are recommended initial androgen-deprivation treatments (ADTs). Nonsteroidal antiandrogen monotherapy merits discussion as an alternative; steroidal antiandrogen monotherapy should not be offered. Combined androgen blockade should be considered. In metastatic or progressive PCa, immediate versus symptom-onset institution of ADT results in a moderate decrease (17%) in relative risk (RR) for PCa-specific mortality, a moderate increase (15%) in RR for non-PCa-specific mortality, and no overall survival advantage. Therefore, the Panel cannot make a strong recommendation for early ADT initiation. Prostate-specific antigen (PSA) kinetics and other metrics allow identification of populations at high risk for PCa-specific and overall mortality. Further studies must be completed to assess whether patients with adverse prognostic factors gain a survival advantage from immediate ADT. For patients electing to wait until symptoms for ADT, regular monitoring visits are indicated. For patients with recurrence, clinical trials should be considered if available. Currently, data are insufficient to support use of intermittent androgen blockade outside clinical trials

Anticancer Activity of Acanthopanax trifoliatus (L) Merr Extracts is Associated with Inhibition of NF-κB Activity and Decreased Erk1/2 and Akt Phosphorylation

“…Early stage prostate cancer requires androgen for growth and thus responds well to androgen deprivation therapy (Loblaw et al, 2007), but tumors become resistant to this therapy as disease progresses (Pilat et al, 1998;So et al, 2005;Schroder, 2008;Chi et al, 2009). Chemotherapy is the primary treatment option for late-stage prostate cancer patients, but this has limited efficacy and serious toxic side effects and the prognosis for these patients is very poor (Gomella et al, 2009;Neri et al, 2009).…”

High-risk prostate cancer: is androgen deprivation monotherapy still appropriate?

“…Although early use of primary ADT appears to improve prostate cancer-specific survival, it does not clearly improve overall survival, 15 perhaps related in part to adverse effects of the ADT. On the one hand, for men who wish to adopt a conservative approach, such as those with limited life expectancy due to age or comorbidities, it may be most reasonable to defer initiation of any therapy until they develop symptomatic progression.…”

A comparison of androgen deprivation therapy versus surgical castration for patients with advanced prostatic carcinoma

“…Although ADT improves survival for undergoing hormone therapy, biochemical recurrence after ADT remains a long-term problem to be solved. The optimal time to initiate hormone therapy for patients with a regular PSA follow-up is still under investigation [3,5,6] . As the modern pharmaceutical industry advanced, a luteinizing hormone-releasing hormone (LHRH) agonist with monthly dosing became available.…”

“…Age is acknowledged as one of the risk factors for prostate carcinoma. With prostate-specifi c antigen (PSA)-based screening and postoperative follow-up being widely used [1][2][3] , the incidence of prostate carcinoma has increased. Androgen deprivation therapy (ADT) is a well-established treatment for advanced and metastatic prostate carcinoma, which began with Huggins's observations on advanced and metastatic prostate carcinoma [4] .…”